Provider Demographics
NPI:1255112868
Name:SANDERS, KHAIRA ELIZABETH (CPHT)
Entity type:Individual
Prefix:MS
First Name:KHAIRA
Middle Name:ELIZABETH
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 VAN BUREN LOOP
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-2767
Mailing Address - Country:US
Mailing Address - Phone:502-690-0109
Mailing Address - Fax:
Practice Address - Street 1:106 W JERSEY AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-3130
Practice Address - Country:US
Practice Address - Phone:813-393-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty